Etiology: Episcleritis is rarely attributable to one of the systemic underlying disorders listed in Table 6.1, and is only occasionally due to bacterial or viral inflammation. Often episcleritis will have no readily discernible cause.

Symptoms: Episcleritis can be unilateral or bilateral. It is usually associated with segmental reddening and slight tenderness to palpation.

Findings: The episcleral vessels lie within the fascial sheath of the eyeball (Tenon's capsule) and are arranged radially. In episcleritis, these vessels and the conjunctival vessels above them become hyperemic (Fig. 6.2). Tenon's capsule and the episclera are infiltrated with inflammatory cells, but the sclera itself is not swollen. The presence of small mobile nodules is typical of nodular episcleritis.

Differential diagnosis: The disorder should be distinguished from conjunctivitis (see next paragraph) and scleritis (6.6.2).

H The conjunctival blood vessels are the most superficial; the episcleral vessels lie within Tenon's capsule and are arranged radially. When vasoconstrictive eyedrops are applied, the conjunctival injection will disappear but not the episcleral injection. This makes it possible to distinguish conjunctivitis from episcleritis.

Treatment and prognosis: Episcleritis usually resolves spontaneously within one to two weeks, although the nodular form can persist for extended periods of time. Severe symptoms are treated with topical steroids (eyedrops) or with a nonsteroidal anti-inflammatory agent.

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